Comparing the Effectiveness of Specific Lumbar Mobilization and Core Stability Exercises in Mechanical Low Back Pain in Decreasing Pain and Disability: A Randomized Control Trial

Specific Lumbar Mobilization and Core Stability Exercises


  • Rehana Hayat Akhtar Saeed Medical & Dental College, Lahore, Pakistan
  • Sumbal Salik Department of Physical Therapy, DHQ Hospital, Okara, Pakistan
  • Shaista Rani Mafaza-Tul-Hayat Hospital, Lahore, Pakistan
  • Amna Zia Mayo Hospital, Lahore, Pakistan
  • Nauman Jamal Akhtar Saeed Medical & Dental College, Lahore, Pakistan
  • Laila Niaz Khan Johar Institute of Professional Studies, Lahore, Pakistan
  • Amna Khalid Faculty of Medical Sciences, Government College University Faisalabad, Faisalabad, Pakistan



Core Stability Exercises, Mechanical Low-Back Pain, Lumbar Mobilizations


Low back pain (LBP) is a global neuro - muscular problem developing significant disability of thoracic, lumbar or sacroiliac joint at any age. Objective: To analysis comparative effectiveness of specific lumbar mobilizations and core stability exercises in mechanical low back pain in reducing pain, ROM and disability. Methods: A patient blinded randomized trial was executed in the department of Physical therapy of Mayo Hospital, Lahore including 45 LBP patients randomly distributed into three groups. Each group received Conventional physical therapy in which Group A was control group, Group B received specific lumbar mobilizations while Group C received core stability exercises. NPRS, RMDQ and MODI were used for assessing pain and disability. SPSS version 24.0 was used for analyzing within and between group analysis through Paired T-test and Independent T- test with p-value <0.05. Results: The results showed conventional therapy, specific lumbar mobilization and core stability exercises are effective in improving pain, ROM and functional status. However; Core stability exercises was more effective with p-values for NPRS (p=0.049), MODI (p=0.038), RMDQ (p=0.003) and for Ranges (R-side flexion; 0.008, L-side flexion; 0.033, R-side rotation; 0.00, L-side rotation; 0.00) as compared to lumbar mobilization. Additionally; there was no substantial difference was found between three groups for flexion and extension. Conclusions: Core stability exercises are statistically and clinically more effective than conventional therapy and specific lumbar mobilizations in improving ROM, decreasing pain and functional status.  



Mostagi FQRC, Dias JM, Pereira LM, Obara K, Mazuquin BF, Silva MF, et al. Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. Journal of Bodywork and Movement Therapies. 2015 Oct; 19(4): 636-45. doi: 10.1016/j.jbmt.2014.11.009.

Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Annals of Translational Medicine. 2020 Mar; 8(6): 299. doi: 10.21037/atm.2020.02.175.

Hoy DG, Smith E, Cross M, Sanchez-Riera L, Blyth FM, Buchbinder R, et al. Reflecting on the global burden of musculoskeletal conditions: lessons learnt from the global burden of disease 2010 study and the next steps forward. Annals of the Rheumatic Diseases. 2015 Jan; 74(1): 4-7. doi: 10.1136/annrheumdis-2014-205393.

Mortazavi J, Zebardast J, Mirzashahi BJA. Low back pain in athletes. Asian Journal of Sports Medicine. 2015 Jun; 6(2): e24718. doi: 10.5812/asjsm.6(2)2015.24718.

Elumalai G, Thangamani M, Sanyal S, Kanagarajan PJ. Deficient sacral hiatus cause mechanical low back pain: a radiological study. International Journal of Anatomy and Research. 2016 Jan; 4(1): 1758-64. doi: 10.16965/ijar.2015.326.

Cooper NA, Scavo KM, Strickland KJ, Tipayamongkol N, Nicholson JD, Bewyer DC, et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal. 2016 Apr; 25: 1258-65. doi: 10.1007/s00586-015-4027-6.

Cougot B, Petit A, Paget C, Roedlich C, Fleury-Bahi G, Fouquet M, et al. Chronic low back pain among French healthcare workers and prognostic factors of return to work (RTW): a non-randomized controlled trial. Journal of Occupational Medicine and Toxicology. 2015 Dec; 10(1): 1-15. doi: 10.1186/s12995-015-0082-5.

Yong RJ, Mullins PM, Bhattacharyya NJ. Prevalence of chronic pain among adults in the United States. Pain. 2022 Feb; 163(2): e328-e32. doi: 10.1097/j.pain.0000000000002291.

Karran EL, Grant AR, Moseley GL. Low back pain and the social determinants of health: a systematic review and narrative synthesis. Pain. 2020 Nov; 161(11): 2476-93. doi: 10.1097/j.pain.0000000000001944.

Jradi H, Alanazi H, Mohammad YJ. Psychosocial and occupational factors associated with low back pain among nurses in Saudi Arabia. Journal of Occupational Health. 2020 Jan; 62(1): e12126. doi: 10.1002/1348-9585.12126.

Krishnan KS, Raju G, Shawkataly O. Prevalence of work-related musculoskeletal disorders: Psychological and physical risk factors. International Journal of Environmental Research and Public Health. 2021 Sep; 18(17): 9361. doi: 10.3390/ijerph18179361.

Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation. 2014 Oct; 17(Suppl 2): 3-10. doi: 10.1111/ner.12018.

Williams JS, Ng N, Peltzer K, Yawson A, Biritwum R, Maximova T, et al. Risk factors and disability associated with low back pain in older adults in low-and middle-income countries. Results from the WHO study on global AGEing and adult health (SAGE). PLoS One. 2015 Jun; 10(6): e0127880. doi: 10.1371/journal.pone.0127880.

Naser SSA and AlDahdooh RM. Lower Back Pain Expert System Diagnosis and Treatment. Journal of Multidisciplinary Engineering Science Studies (JMESS). 2016 Apr; 2(4): 441-6.

Parfenov V and Golovacheva VJ. Diagnosis and treatment of acute low back pain. Terapevticheskii Arkhiv. 2019 Aug; 91(8): 155-9. doi: 10.26442/00403660.2019.08.000315.

Coulombe BJ, Games KE, Neil ER, Eberman LE. Core stability exercise versus general exercise for chronic low back pain. Journal of Athletic Training. 2017 Jan; 52(1): 71-2. doi: 10.4085/1062-6050-51.11.16.

Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. The Spine Journal. 2020 Jul; 20(7): 998-1024. doi: 10.1016/j.spinee.2020.04.006.

Pinto SM, Boghra SB, Macedo LG, Zheng Y-P, Pang MY, Cheung JP, et al. Does motor control exercise restore normal morphology of lumbar Multifidus muscle in people with low back pain?–A systematic review. Journal of Pain Research. 2021 Aug; 14: 2543-62. doi: 10.2147/JPR.S314971.

Ahmed F, Rahman MU, Ullah K, Bhutta AHJ. Combination of core stability exercises and maitland manual therapy is better alternative in the management of chronic low back pain. Journal Riphah College of Rehabilitation Sciences. 2020 Jul; 8(01): S24-S8. doi: 10.5455/JRCRS.202008SI06.

Ibrahim A, Elkeblawy M, Howeidy M, Elkeblawy M, Grase M, Aneis YJ. Effect of Maitland mobilization on lumbar proprioception, pain, and disability in patients with chronic nonspecific low back pain. Physiotherapy Quarterly. 2023 Mar; 31(3): 87-92. doi: 10.5114/pq.2023.125167.

Ali MN, Sethi K, Noohu MMJ. Comparison of two mobilization techniques in management of chronic non-specific low back pain. Journal of Bodywork and Movement Therapies. 2019 Oct; 23(4): 918-23. doi: 10.1016/j.jbmt.2019.02.020.

Almeida DC and Kraychete DCJ. Low back pain-a diagnostic approach. Revista Dor. 2017 Apr; 18: 173-7. doi: 10.5935/1806-0013.20170034.

Akodu AK and Odunfa KS. Core stabilization and Mckenzie back extension exercises on pain, functional disability and insomnia in patients with Non-specific Chronic low back pain (NSCLBP). Journal of the Romanian Sports Medicine Society. 2020; 16(1): 3190-6.

Qaseem A, Wilt TJ, McLean RM, Forciea M. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017 Apr; 166(7): 514-30. doi: 10.7326/M16-2367.

Yakut H, Yakut Y, Doral M. Immediate, short and long-term clinical results of combined Mulligan mobilization with movement techniques in non-specific chronic low back pain: a randomized placebo-controlled trial. Advances in Rehabilitation. 2022 May; 36(2): 1-14. doi: 10.5114/areh.2022.116369.

Sarker K, Sethi J, Mohanty UJ. Comparative clinical effects of spinal manipulation, core stability exercise, and supervised exercise on pain intensity, segmental instability, and health-related quality of life among patients with chronic nonspecific low back pain: A randomized control trial. Journal of Natural Science, Biology and Medicine. 2020 Mar; 11(1): 27-34. doi: 10.4103/jnsbm.JNSBM_101_19.

Meerhoff GA, Verburg AC, Schapendonk RM, Cruijsberg J, Nijhuis-van der Sanden MW, van Dulmen SA, et al. Reliability, validity and discriminability of patient reported outcomes for non-specific low back pain in a nationwide physical therapy registry: A retrospective observational cohort study. Plos one. 2021 Jun; 16(6): e0251892. doi: 10.1371/journal.pone.0251892.

Yao M, Xu BP, Li ZJ, Zhu S, Tian ZR, Li DH, et al. A comparison between the low back pain scales for patients with lumbar disc herniation: validity, reliability, and responsiveness. Health and Quality of Life Outcomes. 2020 Dec; 18(1): 1-12. doi: 10.1186/s12955-020-01403-2.

Ghaderi Niri H, Ghanavati T, Mostafaee N, Salahzadeh Z, Divandari A, Adigozali H, et al. Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Quebec Back Pain Disability Scale: Responsiveness and Minimal Clinically Important Changes in Iranian People with Lumbar Disc Herniation Following Physiotherapy. The Archives of Bone and Joint Surgery. 2024 Jan; 12(1): 58-65.

Javaherian M, Tajali SB, Moghaddam BA, Keshtkar AA, Azizi MJ. Immediate effects of Maitland mobilization and Mulligan techniques on flexion and extension range of motion in patients with chronic nonspecific low back pain: a randomized pilot study. Journal of Modern Rehabilitation. 2017 Apr; 11(2): 127-32.

Islam MW, Tanzir-Uz-Zaman M, Kibria MG, Rahman MM, Hassan MJ, Hossain S, et al. Effectiveness of Core Stabilization Exercise along with Conventional Physiotherapy on Pain, Proprioception and Disability in Patients with Chronic Low Back Pain: A Randomized Control Trial Protocol. Journal of Orthopaedics and Sports Medicine. 2022 Jul; 4(3): 205-10. doi: 10.26502/josm.511500057.

Frizziero A, Pellizzon G, Vittadini F, Bigliardi D, Costantino C. Efficacy of Core Stability in Non-Specific Chronic Low Back Pain. Journal of Functional Morphology and Kinesiology. 2021 Apr; 6(2): 37. doi: 10.3390/jfmk6020037.

Outeda LR, Cousiño LA, Carrera ID, Caeiro EM. Effect of the maitland concept techniques on low back pain: a systematic review. Coluna/Columna. 2022 Jul; 21. doi: 10.1590/s1808-185120222102258429.



DOI: 10.54393/tt.v5i01.191
Published: 2024-03-31

How to Cite

Hayat, R., Salik, S., Rani, S., Zia, A., Jamal, N., Khan, L. N., & Khalid, A. (2024). Comparing the Effectiveness of Specific Lumbar Mobilization and Core Stability Exercises in Mechanical Low Back Pain in Decreasing Pain and Disability: A Randomized Control Trial: Specific Lumbar Mobilization and Core Stability Exercises . THE THERAPIST (Journal of Therapies &Amp; Rehabilitation Sciences), 5(01), 07–13.


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